Assessing patients’ experience of care in four referral hospitals: a cross-sectional survey of outpatients in two South African rural provinces

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BACKGROUND: Patient experience of care surveys are an important component of performance improvement and clinical effectiveness because they serve as a good proxy for patient's satisfaction and the quality of care. The purpose of this study was to assess patients' experience of care in four referral hospitals in two of South Africa's rural provinces. METHODS: A cross-sectional study was conducted in four public hospitals in Eastern Cape (Nelson Mandela Academic (NMAH) and St. Elizabeth (SEH)) and Mpumalanga provinces (Rob Ferreira (RFH) and Themba) for two weeks in July 2022. Systematic random sampling was used to select 662 outpatients. A validated patient experience of care questionnaire measuring demographics, access to care, availability of medicines, cleanliness, staff attitudes and waiting times was used. The level of statistical significance was p-value ≤ 0.05. RESULTS: Females accounted for 71.6% (474/662) of participants; the median age was 47 years and 20.2% (133/657) required assistance with a disability. Only 19.0% (31/659) of patients had been turned away from hospital previously; one hospital was reported to not be clean (68.5%, 111/162); more than two-thirds of Mpumalanga province participants (223/329, 67.8%) reported absence of drinking water (p-value < 0.0001); 68.5% (111/162) of Themba participants did not think that the hospital was clean compared to NMAH's 82.2% (134/163) who thought it was clean (p-value < 0.0001). At least 70% of participants in each of the hospitals found the health professionals to be respectful towards patients (p-value < 0.0001). In all hospitals, at least half of the participants did not know the processes to be followed when lodging a complaint (p-value = 0.002). None of the four hospitals met all the national targets. And only two out of 28 potential domains exceeded 80% or the cut-off score for satisfaction. CONCLUSIONS: Whilst hospitals have been implementing various quality measures to improve patient's experience of care, there are a few concerns such as non-availability of drinking water, lack of knowledge of complaints processes and waiting times that were mostly reported to be unacceptable. Efforts should be made to address the highlighted areas that affect patient experiences to continue improving patient care. TRIAL REGISTRATION: The study forms part of a clinical trial which was registered on 19 May 2022 in the South African National Clinical Trial Registry with ref: DOH-27-052022-6854. The URL of trial registry record is: https://sanctr.samrc.ac.za/ .

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